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American Diabetes Association Antipsychotic Medications

Metabolic Effects Of Combination Therapy With Antipsychotics And Valproate

Metabolic Effects Of Combination Therapy With Antipsychotics And Valproate

Metabolic Effects of Combination Therapy with Antipsychotics and Valproate Treatment of schizophrenia wit Treatment of schizophrenia with antipsychotic medications can increase weight via increases in adiposity, with clinically significant differences in weight gain associated with different antipsychotic medications. While emerging data confirm that antipsychotic-induced weight gain is associated with decreases in insulin sensitivity, few studies have characterized the effect of commonly used forms of psychotropic polypharmacy on changes in adiposity as well as insulin secretion and sensitivity. The addition of valproate to antipsychotic treatment of schizophrenia may be the most commonly used form of multiclass polypharmacy in this population. Frequently sampled insulin-modified intravenous glucose tolerance tests (FSIVGTT) and Bergman[apos]s Minimal Model analysis were used to assess insulin action and beta cell function in nondiabetic schizophrenia patients treated with and without valproate augmentation. In addition, subjects are assessed with DEXA and MRI scans, fasting lipid measurements, and measures of clinical status. Preliminary results confirm adiposity-related changes in insulin sensitivity. Sensitive techniques can be used to assess medication effects of commonly used augmentation strategies that may contribute to disturbances in glucose and lipid metabolism and cardiovascular risk in schizophrenia patients. These results are relevant to clinicians and patients evaluating the risk/benefit ratio of polypharmacy with valproate and atypical antipsychotic medications. DAN W. HAUPT, MARTHA J. HESSLER, KAREN S. FLAVIN, JULIE A. SCHWEIGER, JUSTIN MAEDA, ANGELA LUBER, JOHN W. NEWCOMER 2339-PO St. Louis, MO Insulin Action - Insulin Resistance Continue reading >>

Association Between Atypical Antipsychotic Agents And Type 2 Diabetes: Review Of Prospective Clinical Data

Association Between Atypical Antipsychotic Agents And Type 2 Diabetes: Review Of Prospective Clinical Data

This article has been cited by the following publications. This list is generated based on data provided by CrossRef . Spertus, JacobHorvitz-Lennon, MarcelaAbing, HaleyandNormand, Sharon-Lise2018.Risk of weight gain for specific antipsychotic drugs: a meta-analysis.npj Schizophrenia,Vol. 4,Issue. 1, View all Google Scholar citations for this article. Most evidence suggesting an association between schizophrenia, antipsychotic medications and diabetes has been based on retrospective studies not controlled for important confounders. To compare diabetogenic risk between antipsychotic medications; and to describe the limitations of current prospective data-sets. Systematic review of prospective clinical data. No difference in the incidence of glycaemic abnormalities between placebo cohorts and antipsychotic medication cohorts was identified. No significant difference between any of the antipsychotic medications studied in terms of their association with glycaemic abnormalities was identified. Treatment-related weight gain did not appear to increase the risk of developing diabetes. Diabetogenic potential ascribed to atypical antipsychotic drugs, resulting from retrospective studies, may be incorrect. Cohort sizes and incomplete sampling must preclude any definitive conclusions. Long-term, large, comparative prospective trials are needed, along with agreement upon glucose measurement of choice. To send this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the name part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle . No Continue reading >>

Consensus Development Conference On Antipsychotic Drugs And Obesity And Diabetes

Consensus Development Conference On Antipsychotic Drugs And Obesity And Diabetes

The SGAs are of great benefit to a wide variety of people with psychiatric disorders. As with all drugs, SGAs are associated with undesirable side effects. One constellation of adverse effects is an increased risk for obesity, diabetes, and dyslipidemia. The etiology of the increased risk for metabolic abnormalities is uncertain, but their prevalence seems correlated to an increase in body weight often seen in patients taking an SGA. Direct drug effects on -cell function and insulin action could also be involved, since there is insufficient information to rule out this possibility. In the general population, being overweight or obese also carries a much higher risk of diabetes and dyslipidemia. These three adverse conditions are closely linked, and their prevalence appears to differ depending on the SGA used. Clozapine and olanzapine are associated with the greatest weight gain and highest occurrence of diabetes and dyslipidemia. Risperidone and quetiapine appear to have intermediate effects. Aripiprozole and ziprasidone are associated with little or no significant weight gain, diabetes, or dyslipidemia, although they have not been used as extensively as the other agents. The choice of SGA for a specific patient depends on many factors. The likelihood of developing severe metabolic disease should also be an important consideration. When prescribing an SGA, a commitment to baseline screening and follow-up monitoring is essential in order to mitigate the likelihood of developing CVD, diabetes, or other diabetes complications. Do you want to read the rest of this article? ... It is difficult to determine whether the prevalence of obesity and metabolic changes with an increased risk of 1.5-2 times more than the general population in schizophrenia patients is independent of Continue reading >>

Metabolic Screening After The American Diabetes Association's Consensus Statement On Antipsychotic Drugs And Diabetes

Metabolic Screening After The American Diabetes Association's Consensus Statement On Antipsychotic Drugs And Diabetes

Metabolic Screening After the American Diabetes Association's Consensus Statement on Antipsychotic Drugs and Diabetes We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Metabolic Screening After the American Diabetes Association's Consensus Statement on Antipsychotic Drugs and Diabetes Elaine H. Morrato, DRPH, MPH, John W. Newcomer, MD, [...], and Brian Cuffel, PHD Several second-generation antipsychotic (SGA) drugs have been associated with weight gain, hyperglycemia, and dyslipidemia. We evaluated whether glucose and lipid testing increased after the American Diabetes Association (ADA) consensus statement recommending metabolic monitoring for SGA-treated patients. Laboratory claims for serum glucose and lipid testing were identified for an incident cohort of 18,876 adults initiating SGA drugs in a U.S. commercial health plan (20012006) and a control group of 56,522 adults with diabetes not receiving antipsychotics. Interrupted time-series models were used to estimate the effect of ADA recommendations on baseline and annual testing trends after adjusting for differences in age, sex, mental health diagnoses, and cardiovascular risk using propensity score matching. Mean baseline testing rates for SGA-treated patients during the study period were 23% (glucose) and 8% (lipids). Among persistent users of SGA medication, annual testing rates were 38% (glucose) and 23% (lipid). Before the ADA statement, screening rates for SGA-treated pa Continue reading >>

Antipsychotics And The Risk Of Diabetes: A General Data Review

Antipsychotics And The Risk Of Diabetes: A General Data Review

Volume 20, Supplement 4 , December 2005, Pages S349-S357 Antipsychotics and the risk of diabetes: A general data review Author links open overlay panel T.Bottaia P.Quintinbc Get rights and content Recently, attention has focused on a potential link between schizophrenia and diabetes, with speculation that this potential associationis stronger in patients who are prescribed atypical antipsychotics. Pharmacoepidemiological studies can help to evaluate this potential association. Source data on the incidence of diabetes in patients treated with antipsychotics is available in the FDA MedWatch database, prescription claims databases and other patient registries. These data indicate that antipsychotic drugs may increase the risk of developing diabetes and that there may be an interaction with age. However, current data are insufficient to accurately assess potential differences in the risk of diabetes between users of individual antipsychotic medications. In addition, antipsychotic treatment-emergent diabetes has several distinct features, notably relating to age of onset, gender ratio, rate of deterioration of glycaemic control, and independence from initial treatment emergent weight gain. Nonetheless, guidelines for the control of risk factors for diabetes developed for the general population appear to be applicable to patients with schizophrenia. Continue reading >>

Atypical Antipsychotic-induced Type 2 Diabetes

Atypical Antipsychotic-induced Type 2 Diabetes

Atypical Antipsychotic-Induced Type 2 Diabetes Jennifer Berg, PharmD, Gregory Stajich, PharmD, and Martin Zdanowicz, PharmD Patients with schizophrenia and other disorders who take atypical antipsychotics should be monitored for an increased risk for diabetes. Reducing the Risk for Metabolic Disorders Begins with Choosing the Right Treatment Patients taking antipsychotic agents, and particularly those with schizophrenia, are at risk for developing more detrimental conditions that can lead to increased susceptibility to cardiovascular disease and hyperlipidemia. Since 2002, coinciding with the addition of the newer generation of atypical antipsychotic drugs, patients have also been prone to an increase in weight gain and the subsequent metabolic effects leading to a predilection to type 2 diabetes. According to the National Institute of Mental Health, in 2008, 2.4 million people in the United States were living with schizophrenia.1 Schizophrenia is a mental disorder characterized by positive symptoms like delusions, hallucinations, and disorganization of thought, and negative symptoms such as flat affect, avolition, alogia, anhedonia, and social inattention.2,3 In addition to the mental complications of the disorder, studies have shown that patients with schizophrenia are 2 to 3 times more likely to develop type 2 diabetes.4 There is not a clear understanding why schizophrenic patients are at an increased risk for developing type 2 diabetes. Schizophrenic patients have a number of risk factors for type 2 diabetes, including family history, increased body mass index (BMI), sedentary lifestyle associated with the disorder, and the use of atypical antipsychotic medications.5 In 2004, the FDA required that a warning be placed in the package inserts of all atypical antipsych Continue reading >>

Metformin Reversed Weight Gain From Certain Antipsychotic Drugs

Metformin Reversed Weight Gain From Certain Antipsychotic Drugs

Diabetes drug may be a feasible alternative in the battle against antipsychotic drug-induced weight gain. Patients who take antipsychotic medications can turn to lifestyle intervention and metformin, a potential combination to fight weight gain. The link between antipsychotic medications and weight gain is well known, and there is growing concern that use of these medications may also be related to potentially serious adverse metabolic effects, such as hyperlipidemia and glucose intolerance. “To maintain a balanced weight is often challenging, but especially so for patients with schizophrenia due to their poor diet, sedentary lifestyle and long-time need for antipsychotic medication,” researchers in Hunan, China and San Diego wrote in the Journal of the American Medical Association. Based on their findings, the researchers recommended lifestyle intervention plus metformin as the go-to therapy for patients taking antipsychotic medications. The researchers conducted a randomized controlled trial of 128 patients with schizophrenia treated at the Mental Health Institute of the Second Xiangya Hospital, Central South University, in China. Patients taking atypical antipsychotic therapy who gained more than 10% of their predrug weight were randomly assigned to four treatment groups: metformin 750 mg per day, metformin 750 mg per day plus lifestyle intervention, lifestyle intervention alone, or placebo. All patients continued their antipsychotic treatment. “In this 12-week study, we found statistically significant decreases in mean weight, BMI, waist circumference, insulin and insulin resistance index among patients in the lifestyle plus metformin, metformin alone and lifestyle plus placebo groups, but not among those in the placebo alone group whose measurements continued Continue reading >>

Metabolic Screening Before And After The Ada Consensus Statement On Antipsychotic Drugs And Risk Of Diabetes And Dyslipidemia

Metabolic Screening Before And After The Ada Consensus Statement On Antipsychotic Drugs And Risk Of Diabetes And Dyslipidemia

Metabolic Screening before and after the ADA Consensus Statement on Antipsychotic Drugs and Risk of Diabetes and Dyslipidemia Patients with serious mental i Patients with serious mental illness are at increased risk for diabetes and cardiovascular disease. The use of certain antipsychotic (AP) medications increases risk for metabolic disorders. The 2004 ADA Consensus Statement recommends serum glucose and lipid testing at AP drug initiation. We estimate rates of baseline glucose and lipid screening and evaluate if screening rates increased following ADA recommendations in comparison to background trends. Laboratory claims for serum glucose and lipid testing were identified for an incident cohort of 18,176 adults initiating widely used atypical AP drugs in a US commercial health plan (2000-2006) and a control group of 56,522 adults with diabetes not receiving antipsychotics. Rates of testing were compared after adjusting for age, sex, mental health disorders and cardiovascular risk using propensity score matching (N=8,759 matched pairs). Interrupted time series models were used to measure the effect of the ADA Statement on trends in baseline testing rates (30 days before/after AP drug initiation). In the unmatched incident cohort, AP patients had low rates of glucose (23%) and lipid testing (8%) at the time of drug initiation. Rates were higher if they had pre-existing diabetes (glucose testing: 36% vs. 21%, p<0.001; lipid testing: 14% vs. 7%, p= p<0.001). Background trends in glucose testing were increasing before the ADA Statement at a faster rate for controls compared to AP patients (22% vs. 0.85%/quarter, p=0.03). Trends in lipid testing were similarly increasing faster for controls compared to AP patients (9% vs. 0.5%/quarter, p=0.002). The ADA Statement was not as Continue reading >>

Antipsychotic-induced Diabetes Mellitus

Antipsychotic-induced Diabetes Mellitus

Joshua J. Neumiller, PharmD, CDE, CGP, FASCP ABSTRACT: Several metabolic consequences ofantipsychotic use have been described within the literature, includingweight gain, hyperglycemia, and dyslipidemia. While the exact mechanismsof antipsychotic-induced metabolic dysfunction are unknown, there are avariety of proposed mechanisms. Since weight gain is considered aprecipitating factor for the development of diabetes and dyslipidemia,monitoring of weight changes with antipsychotic treatment is animportant screening measure. As some antipsychotic agents are lesslikely to contribute to weight gain, such as aripiprazole andziprasidone, it seems prudent to choose a lower-risk antipsychotic inpeople who are at high risk for or have a preexisting diagnosis ofdiabetes or in whom hyperglycemia, dyslipidemia, and/or substantialweight gain develops. Diabetes mellitus (DM) is the seventh leading cause ofdeath in the United States and is a major cause of renal failure, newonset blindness, and nontraumatic limb amputations.1 DMadditionally places people at risk for adverse cardiovascular outcomesand is a major contributor to the incidence of stroke and heart disease.National estimates indicate that DM affects 8.3% of the U.S.population, which equates to a staggering 25.8 million people, and theincidence of DM is continuing to grow at an alarming rate.1 While the health and economic consequences of type 2 DM(T2DM) are widely known, the contribution of medications to thedevelopment of T2DM is sometimes less well recognized. One class ofdrugs for which there are large amounts of clinical data to substantiatea link between their use and the development of T2DM is antipsychoticmedications. This article will provide an overview ofantipsychotic-induced DM and current recommendations pertain Continue reading >>

Atypical Antipsychotics And New-onset Type 2 Diabetes In Patients With Schizophrenia

Atypical Antipsychotics And New-onset Type 2 Diabetes In Patients With Schizophrenia

Atypical Antipsychotics and New-Onset Type 2 Diabetes in Patients with Schizophrenia Shahzad Iqbal, MD, and Deepak Thomas, MD, Interfaith Medical Center, Brooklyn, NY The relationship between atypical antipsychotics and hyperglycemia is not completely understood. Epidemiologic studies have shown an increased incidence of diabetes among patients with schizophrenia. We conducted a study to investigate the relationship between atypical antipsychotic therapy and the risk for diabetes. We analyzed data retrospectively from the medical records of 977 patients with schizophrenia who were started on atypical antipsychotics. At 15 weeks, 6 patients developed type 2 diabetes, with an average of 8 weeks to disease onset. All 6 patients gained weight while taking these medications. The results of our study suggest that patients who gain weight while taking atypical antipsychotics are at greater risk for incident diabetes. Such patients will need frequent monitoring of fasting blood glucose levels. If diabetes is diagnosed, patients may need insulin therapy initially, but most could eventually achieve glycemic control with oral hypoglycemic agents. Diabetes is a major health problem in the United States, and its incidence as well as prevalence are increasing worldwide.1 Epidemiologic studies indicate an increased prevalence of type 2 diabetes in patients with schizophrenia.2 Evidence from the 1989 National Health Interview Survey, which was conducted before the widespread use of atypical antipsychotic medications, showed that women with schizophrenia had a significantly higher body mass index (BMI) than the general population (27.36 kg/m2 versus 24.50 kg/m2, respectively).3 Schizophrenia is also associated with an increased risk for cardiovascular morbidity and mortality, which is Continue reading >>

Improving Metabolic Screening For Patients On Antipsychotic Therapy

Improving Metabolic Screening For Patients On Antipsychotic Therapy

Improving Metabolic Screening for Patients on Antipsychotic Therapy Authors: Joseph Parks, MD; Ginger Nicol, MD; John Newcomer, MD This activity is intended for psychiatrists, psychiatric nurses, and nurse practitioners; primary care providers; and other clinicians engaged in the treatment of patients with severe mental illness. The goal of this activity is to outline the cardiometabolic screening recommendations for patients who are taking antipsychotics and strategies for incorporating them into routine practice. Upon completion of this activity, participants will be able to: Describe barriers to evidence-based screening for patients receiving antipsychotic treatment Propose methods for aligning clinical procedures and policies with guidelines for metabolic screening As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content. Distinguished Research Professor, University of Missouri; Director, Missouri Institute of Mental Health; Medical Director, Missouri Department of Mental Health, St. Louis, Missouri Disclosure: Joseph Parks, MD, has disclosed the following relevant financial relationships: Served as an advisor or consultant for: Brain Resource Ltd. Served as a speake Continue reading >>

Adverse Effects Of Antipsychotic Medications

Adverse Effects Of Antipsychotic Medications

Adverse Effects of Antipsychotic Medications JOHN MUENCH, MD, MPH, Oregon Health & Science University, Portland, Oregon ANN M. HAMER, PharmD, BCPP, Oregon State University College of Pharmacy, Corvallis, Oregon Am Fam Physician.2010Mar1;81(5):617-622. The use of antipsychotic medications entails a difficult trade-off between the benefit of alleviating psychotic symptoms and the risk of troubling, sometimes life-shortening adverse effects. There is more variability among specific antipsychotic medications than there is between the first- and second-generation antipsychotic classes. The newer second-generation antipsychotics, especially clozapine and olanzapine, generally tend to cause more problems relating to metabolic syndrome, such as obesity and type 2 diabetes mellitus. Also, as a class, the older first-generation antipsychotics are more likely to be associated with movement disorders, but this is primarily true of medications that bind tightly to dopaminergic neuroreceptors, such as haloperidol, and less true of medications that bind weakly, such as chlorpromazine. Anticholinergic effects are especially prominent with weaker-binding first-generation antipsychotics, as well as with the second-generation antipsychotic clozapine. All antipsychotic medications are associated with an increased likelihood of sedation, sexual dysfunction, postural hypotension, cardiac arrhythmia, and sudden cardiac death. Primary care physicians should understand the individual adverse effect profiles of these medications. They should be vigilant for the occurrence of adverse effects, be willing to adjust or change medications as needed (or work with psychiatric colleagues to do so), and be prepared to treat any resulting medical sequelae. FGAs with lower potency dopamine D2 neurorecepto Continue reading >>

Recommendations For Lab Monitoring Of Atypical Antipsychotics

Recommendations For Lab Monitoring Of Atypical Antipsychotics

Recommendations for lab monitoring of atypical antipsychotics Current Psychiatry. 2013 September;12(9):51-54 Second-Year Pharmacy Resident in Psychiatry Second-Year Pharmacy Resident in Psychiatry Director of Osteopathic Psychiatric Residency Program Christopher J. Thomas, PharmD, BCPS, BCPP, CGP Clinical Associate Professor of Pharmacology Ohio University College of Osteopathic Medicine Chillicothe Veterans Affairs Medical Center 1. American Diabetes Association. Executive summary: standards of medical care in diabetes2010. Diabetes Care. 2010;33: 2. American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, and the North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004;27(2):596-601. 3. Kahn RS, Fleischhacker WW, Boter H, et al; EUFEST study group. Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet. 2008;371(9618):1085-1097. 4. Tarricone I, Ferrari Gozzi B, Serretti A, et al. Weight gain in antipsychotic-naive patients: a review and meta-analysis. Psychol Med. 2010;40(2):187-200. 5. De Hert M, Yu W, Detraux J, et al. Body weight and metabolic adverse effects of asenapine, iloperidone, lurasidone and paliperidone in the treatment of schizophrenia and bipolar disorder: a systematic review and exploratory meta-analysis. CNS Drugs. 2012;26(9):733-759. 6. De Hert M, Dobbelaere M, Sheridan EM, et al. Metabolic and endocrine adverse effects of second-generation antipsychotics in children and adolescents: a systematic review of randomized, placebo controlled trials and guidelines for clinical practice. Eur Psychiatry. 2011;26(3):144 Continue reading >>

Metabolic Monitoring For Patients On Antipsychotic Medications: Page 4 Of 4

Metabolic Monitoring For Patients On Antipsychotic Medications: Page 4 Of 4

Metabolic Monitoring for Patients on Antipsychotic Medications: Page 4 of 4 Table 1 Metabolic monitoring parameters based on American Diabetes Association/American Psychiatric Association consensus guidelines Table 2 American Diabetes Association diagnostic criteria for diabetes In primary and general medical practice, the relevance and importance of metabolic syndrome as a construct and as a risk marker are often debated. Guidelines for the management of hyperlipidemia are grounded on the Framingham assessment, which is based on total and low-density lipoprotein cholesterol levels. Moreover, 4 of the 5 metabolic syndrome criteriametabolic dyslipidemia (raised triglyceride and low high-density lipoprotein cholesterol levels), abdominal adiposity (increased waist circumference), and dysglycemia (increased glucose levels)are markers of antipsychotic metabolic effects.14 Not surprisingly, rates of metabolic syndrome are consistently elevated in adult samples of patients with serious mental illness, and fasting insulin levels (equivalent to metabolic syndrome) are elevated in younger patients with early psychosis.15-17 Therefore, it can be argued that metabolic syndrome has added relevance as a risk marker for patients treated with antipsychotics, an issue often not recognized by primary care providers. In terms of equipment, practitioners should have a digital scale, blood pressure cuff, and tape measure easily accessible in the office. Office scales only measure up to 300 or 350 lb; clinics or hospitals should ensure access to a more advanced scale for patients who weigh more. Practitioners may find it useful to designate 1 month of every 6 or 12 months to focus on metabolic monitoring and to ensure that every patient in the caseload is monitored. It helps to define the Continue reading >>

Ada: Metabolic Monitoring Guidelines For Antipsychotics Largely Unheeded

Ada: Metabolic Monitoring Guidelines For Antipsychotics Largely Unheeded

ADA: Metabolic Monitoring Guidelines for Antipsychotics Largely Unheeded by Crystal Phend Crystal Phend, Staff Writer, MedPage Today Explain to interested patients that second-generation antipsychotics increase weight gain and may put patients at risk for diabetes and cardiovascular disease. Note that these studies were published as abstracts and presented as posters at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal. SAN FRANCISCO, June 12 -- Recommendations for lipid and glucose monitoring for patients on atypical antipsychotic drugs have made scarcely a dent on clinical practice, researchers found. Metabolic screening and monitoring rates rose by 5% or less since 2004, when the FDA warned of increased diabetes and cardiovascular risk with antipsychotic medications, according to two separate analyses of large insurance claim databases reported here at the American Diabetes Association meeting. Only about 20% of patients on second-generation antipsychotics received recommended glucose monitoring and just 10% had lipids monitored, reported Dan W. Haupt, M.D., of Washington University in St. Louis, and colleagues in one of the studies. Changes in screening rates were no better than, and in some cases worse, for patients starting antipsychotics than for other commercially-insured patients, found Elaine Morrato, Dr.P.H., M.P.H., of the University of Colorado in Denver, and colleagues in the other study. In 2004, the FDA asked manufacturers of atypical antipsychotics to add a warning of the risk of hyperglycemia and diabetes with these medications. Around the same time, the ADA, American Psychiatric Association, and other groups issued a joint consensus statement recommending that doctors screen and Continue reading >>

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